Supervises all staff and functions for insurance denials management and follow up within patient financial services office. Serves as the overall Boys Town National Research Hospital (BTNRH) insurance billing expert and point of escalation, to include supervising follow-up specialist staff and processes to resolve unpaid, denied, or incorrectly paid insurance claims, including necessary refunds. Supervises workflows for insurance follow-up staff, research payer issues that result in denials and presents findings for payer trends to PFS leadership.
SCHEDULE: Monday-Friday 8a-5p
MAJOR RESPONSIBILITIES & DUTIES:
Facilitates and provides direct oversight to Insurance Follow-Up Specialists, serving as the groups liaison with other billing office groups, as well as departments and leaders outside of PFS as it relates to insurance billing, denials, aged A/R, rejections, credits, and underpayments.
Accountable for providing ample orientation and ongoing training of Insurance Follow-Up Specialists.
Continuously monitors follow-up specialist's staff's workloads and assignments, to ensure no A/R is unassigned, and that staff assignments are set-up in such a way to avoid all timely filing and appeals adjustments at or below set performance standards, as set forth by the Patient Financial Services Director.
Performs monthly audits of personnels productivity and ensures quality at the departments defined standards. Compiles audit results and findings, tracks and trends each staffs ongoing results and communicates findings to management, while coaching and mentoring staff when below standard results and trends exist.
Tracks, trends, analyzes and implements changes to fix/reduce payer denials and rejections. This includes using system and workflow updates, education of staff and work with payer representatives and management to achieve goals (quarterly and annual) within the patient financial services office, focusing on effectiveness and efficiency.
Maintains current knowledge of various payer specific contracts and policies, as they relate to denials and rejections, as well as ensuring staff is kept abreast of pertinent payer information allowing the staff to ensure BTNRH is being reimbursed correctly, while having the ability to make sound business decisions based on the current payer contract information.
Assists in related system design, build, validation and training specific to contract management and communicates information necessary for follow up/appeal if the payer response received is incorrect.
Runs, validates and distributes insurance follow up denials, rejections, performance, and production to staff and management on set schedules.
Maintains supervision of insurance credit balances, ensuring the staff works the credit balances within the compliance guidelines of BTNRH.
Actively fosters excellent teamwork to assist in achieving the mission, while offering assistance to solving complex problems while responding effectively to crisis and unplanned events in a timely and confidential manner.
Oversees the interviewing, selection, evaluation of performance and coaching of Insurance Follow-Up Specialists.
Manages direct reports timecards on a weekly basis, minimizing overtime situations and consulting employees of discrepancies when identified.
Communicates appropriately using good interpersonal skills, ensuring that a positive, professional demeanor is projected through verbal and non-verbal communications, ensuring information for patients is delivered in a manner that is supportive, timely and understandable.Reviews adjustment requests for completion and accuracy from insurance follow-up specialists, approves and routes adjustments correctly within the appropriate approval and turnaround time guidelines, as determined by the PFS Director.
KNOWLEDGE, SKILLS, AND ABILITIES:
Communicate professionally, clearly and concisely, both orally and in writing, with all BTNRH staff, physicians and patients in all aspects of the job to allow for high levels of efficiency and promptness for patient care.
Function independently and with limited supervision.
Knowledge in UB92, HCFA 1500 Hospital Insurance Claims forms and their requirements, which includes in depth knowledge of the most current version of ANSI 837 electronic claims files, loops and segments, along with understanding of CPT, HCPCS, ICD10 as related to denials and payments.
Knowledge in claims clearinghouse capabilities and related build and set up.
Problem solve, and to apply exceptional analytical skills to creatively resolve issues and organize workload according to established priorities.
Strong attention to detail, goal oriented and confidence in making independent decisions.
Knowledge of denials and their effect on revenue cycle operations.
Knowledge of Microsoft PC applications, such as Outlook, Word and Excel.
Serve as a positive role model for the billing office and to support the mission of BTNRH.
High school diploma or equivalent required.
Minimum of 5 years experience in health care, with focus on hospital claims/denials required.
Extensive experience in healthcare billing, reimbursement issues and rules and regulations for insurance payers is required.
Previous lead or supervisory experience required.
About Boys Town:
Boys Town has been changing the way America cares for children and families since 1917. With over a century of service, our employees have helped us grow from a small boardinghouse in downtown Omaha, Nebraska, into one of the largest national child and family care organizations in the country. With the addition of Boys Town National Research Hospital in 1977, our services branched out into the health care and research fields, offering even more career opportunities to those looking to make a real difference.
Our employees are our #1 supporters when it comes to achieving Boys Town's mission, which is why we are proud of their commitment to making the world a better place for children, families, patients, and communities. Unique perks to Boys Town employees and their families include free visits to Boys Town physicians and free prescriptions under the Boys Town Medical Plan, tuition assistance, parenting resources from our experts and professional development opportunities within the organization, just to name a few. Working at Boys Town is more than just a job, it is a way of life.
This advertisement describes the general nature of work to be performed and does not include an exhaustive list of all duties, skills, or abilities required. Boys Town is an equal employment opportunity employer and participates in the E-Verify program. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and/or expression, national origin, age, disability, or veteran status. To request a disability-related accommodation in the application process, contact us at 1-877-639-6003.